Episodes of behavioural disturbance are commonplace on neurology wards. The key to their safe management is prior planning, including securing the safety of the ward environment, and a formal risk assessment. Protocols which define staff roles and the unit strategy for the management of behavioural disturbance should be formally agreed and appropriate training provided. The commonest cause of disturbed behaviour in neurology—and neurosurgical wards—is delirium. This presents with fluctuating orientation, grossly impaired attention and disruption of the sleep–wake cycle. The cause is generally multifactorial with a combination of pre-existing vulnerabilities and acute precipitants. Management reflects this and depends on a multifaceted approach to medical care, including basic supportive measures, minimising polypharmacy and promoting orientation, early mobilisation and nutritional status, as well as treating the underlying medical conditions. Antipsychotic medication has a specific treatment effect but never as the only approach to the management of the delirious patient.